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NB-IRDT researchers studied years of data about mortality and short-term complications from three common surgical procedures in New Brunswick.

When it comes to minimizing the odds of complications from surgery, New Brunswickers should choose providers who actively and regularly perform a large number of similar surgeries, according to findings from the New Brunswick Institute for Research, Data, and Training (NB-IRDT) at the University of New Brunswick. 

NB-IRDT researchers linked years of physician billing data with pseudonymized Medicare data to discern the rate of complications and/or mortality within 30 days from three high-volume surgical procedures: total hip arthroplasty or hip replacements, Caesarean sections (C-sections), and colorectal surgery. 

“Prior research has focused primarily on hospital volume because of limited availability of data. Because we can link multiple province-wide data sets on our data platform, we were able to look deeper to see if physician training and experience had an impact as well,” says Dr. McDonald.

“We found that lower levels of physician experience and caseload volume are associated with significantly greater risk of complications for C-sections. Lower caseload volumes are associated with higher risk of complications for colorectal surgery but to a much lesser extent. But in general, busier surgeons are associated with fewer complications," says Dr. McDonald.

For every additional C-section performed by an individual surgeon, the likelihood of complications decreased by 0.5%. That translates to a 4.5% decrease in the rate of complications for every 10 C-sections performed. For colorectal surgeries, the impact of caseload volume was smaller but still statistically significant. 

The study on total hip replacements only looked at mortality and found there is no statistically significant risk of mortality associated with caseload volume either at the provider or hospital level. 

“This research is particularly important to provinces like New Brunswick that have several smaller, more rural hospitals that serve larger geographic areas with low populations,” says Dr. McDonald.  

“We found that it isn’t necessarily small hospitals but small caseloads per physician that really have an impact on surgical outcomes for these procedures. But a surgeon at a small hospital will have a hard time logging the same number of similar procedures as one practicing at a larger, regional hospital. The patient numbers aren’t there,” explains Dr. McDonald. 

This shouldn’t alarm patients at small hospitals too much since Dr. McDonald says the overall odds of complications for all surgeries studied is still low. “The impact of physician experience on risk of complications is small compared to the risks posed by a patient’s own health status,” says Dr. McDonald. “Your best chance of avoiding complications from surgery is to look after your own health as best you can.”  

“However, if populations in the catchment areas of smaller hospitals continues to decline, health care leaders may have to consider how to address issues of low surgical caseload volumes to minimize the impact on patient safety.” 

The C-section study was published in BMC Pregnancy and Childbirth and the colorectal surgery and total hip replacement studies were accepted for publication in Canadian Journal of Surgery.

About the NB-IRDT

The New Brunswick Institute for Research, Data, and Training (NB-IRDT) is New Brunswick’s secure data repository for anonymized administrative and health data from the Government of New Brunswick and other public bodies. Headquartered on the Fredericton campus of the University of New Brunswick, the NB-IRDT has satellite offices at the University of New Brunswick Saint John and Université de Moncton. Resident researchers assist with the design, execution, interpretation, reporting of research projects and program assessment.

Available for interviews:

• Dr. Phil Leonard, English
• Dr. Ted McDonald, English print or online (no radio)
• Jonathan Boudreau, French 

Media contact: Mara Mallory, University of New Brunswick, mara.mallory@unb.ca, cell: (506) 292-0720

Photo credit: Mara Mallory/UNB